Andrew Goldstein Profile picture
Apr 7, 2020 13 tweets 3 min read Read on X
If we care about maximizing health for all, and ensuring health equity, we have to overcome some major issues in how we confront problems as a society.

"Public health" is a big part of that toolkit, but it is inadequately understood and appreciated outside of the field. 1/
Glaringly, it's #PublicHealthWeek.

... in a time when many don't know what "public health" really means

... even as we find ourselves in the midst of a pandemic. 2/
Explore "what is public health" searches online yourself, but to me, public health is a field with the goal of and tools for understanding and preventing suffering and death *at the macro level.* 3/
A lot of the focus is on identifying optimal, possible moments for prevention.

And I think the important lesson to me during the COVID-19 pandemic, is that not all moments to prevent massive health threats are the same. 4/
Some moments are clear cut and immediate emergencies, like a hurricane or an asteroid on a collision course.

But many lack core features of these threats: observability, immediacy, definitiveness, and relevance to those in power. 5/
Some are massive but less clear: possible-pandemics, climate crisis.

Others are ongoing, everyday, quiet but massive: food/water/air safety, gun violence, transit crashes, physical inactivity, social isolation, substances like tobacco. 6/
To me there are 2 big meta-issues for public health:

First, we under-communicate the averted disasters and the systems used to avert them. 7/
If we blow up a collision course asteroid, its destruction is visible but also its collision is imaginable and rememberable even after its destruction. 8/
Saving lives from dirty air or with a pandemic prevention system doesn't build in the "noticing" of lives saved or appreciation for the systems used to save the live.

These features aren't baked in. We need to communicate these better. 9/
Second, all public health is political, and the field has, overall, been ignorant or naive about this.

Communication, science, reports, and lobbying are inadequate. We must build power and wield power.

There are too many vested interests resisting our agenda. 10/
Thankfully, on that note, there are great efforts emerging. 11/
E.g.

@PHAwakened is a politically active (though non-partisan) community of public health professionals.

The field is increasingly conscious of the #PoliticalDeterminantsOfHealth.

Public health workers are getting involved in direct action, mutual aid, and elections. 12/
Ok to wrap up, humanity needs the public health approach to tackle inequities/inadequacies of approaching illness late and only at the individual-level.

And, public health needs to politicize, shift narratives, and *show itself.*

#NPHW #WeArePublicHealth 13/

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More from @AndrewMakeTweet

Mar 3, 2022
"Protecting the vulnerable"
"Protecting hospital capacity"
"Preventing variants"

Are good rhetoric, but do the policies make sense for these goals? Are these goals enough?

No. A mini-🧵.
The policies don't live up to the words once we consider the realities of:
– US healthcare inaccessibility
– pre-/asymptomatic spread
– people living with others
– chains of transmission
– exponential growth
– levels of immunity
This doesn't even include the issues with the continued shifting of responsibility to states, municipalities, and individuals, and the delay in implementation and effects of implementation once supposed policy/behavior triggers are met by indicators.
Read 5 tweets
Feb 25, 2022
CDC mask guidance change 🧵

1) Hospitalizations lag test positive cases which lag actual cases

2) Guidance based more on hospitalizations means willfully abandoning critical windows to act

3) So this guidance is less about new science or better public health, and more about…
... both justifying the relaxation of public health protections now and about justifying too little, too late policy responses in the future when surges re-emerge.
This is – in contrast to "evidence-based policymaking" – policy-based guidancemaking.

It is irresponsible and inappropriate for health experts and public health authorities to create this or champion it in their messaging work.
Read 24 tweets
Feb 24, 2022
War is bad for everyone except the wealthy and powerful.

It's pathetic and tragic that most of humanity has little it can offer except condemnation.

We deserve democratic global institutions capable of preventing and dealing with conflict. 1/
Borders and nations are artificial.

Powerful nations and the powerful within all nations use to these constructs to their advantage.

But there are other constructs that show how ridiculous this is. 2/
To me this invasion is as preposterous as Florida invading Georgia.

Just as one US state invading another is essentially inconceivable and impossible in 2022, we need democratic and representative global institutions empowered to prevent and deal with international conflict. 3/
Read 5 tweets
Feb 5, 2022
Let's highlight how "civility politics" operates in pandemic discourse. 🧵

1) Highly platformed health "experts" drive policy negligence with their incorrect, harmful messaging. They get bylines, journalist interviews, TV appearances, book deals, and wide rightwing celebration.
2) The health "experts" face a backlash. Some of it is admittedly unkind and personal, but most was civil, valid criticism or very fair sharing of real and raw emotion from people who have endured awful policy violence these experts have fostered.
3) These health "experts" have a choice. They can respond to substantive criticisms, they can show up for debates, they can reflect on if their prior predictions were accurate or prior prescriptions worked out well. Or they can seek to deflect the backlash.
Read 10 tweets
Dec 12, 2021
Here's a 🧵 reviewing this op-ed from @MonicaGandhi9 and @LeslieBienen.

Spoiler: incoherence, obfuscation, and omission that feeds pandemic inaction + promoting a data reporting approach that destroys opportunities to save lives and prevent suffering.

First off, why is the NYTimes continuing to platform voices that have consistently been incorrect?

Premature optimism, essentially calling the pandemic over, has driven real harm by degrading policy protections and public behavior.

Who was the editor here?
How's this essay start?

Highlighting Omicron, and what isn't known about.

What's neglected? Omitted? Ignored?

The current surge in *Delta* cases, hospitalizations, and deaths, with 1,000+ deaths most days for months, and projections of another 100,000+ dead in coming months.
Read 21 tweets
Dec 11, 2021
Rapid test are probably able to catch about half of presymptomatic cases.

They're neither perfect nor insignificant, which makes them a great layer of protection to use with others. 1/
That means at the population level, pre-gathering rapid tests may halve the rates of infectious people attending. 2/
But a more meaningful question, at the level of an individual gathering might be:

"What is the chance of anyone attending this gathering being infectious?"

I.e. the chance of one or more people being infectious. 3/
Read 5 tweets

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